Connecticut medicine
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Connecticut medicine · Aug 1999
Case ReportsRhabdomyolysis associated with the combined use of hydroxymethylglutaryl-coenzyme A reductase inhibitors with gemfibrozil and macrolide antibiotics.
The hydroxymethylglutaryl-coenzyme A reductase inhibitors (HMG-CoAs) are one of the most significant causes of medication induced rhabdomyolysis. The development of rhabdomyolysis is increased when the HMG-CoAs are used concurrently with certain other medications, specifically gemfibrozil and macrolide antibiotics. In this report, we describe a patient with rhabdomyolysis from the combined use of lovastatin, gemfibrozil, and clarithromycin and review the relevant literature.
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Connecticut medicine · Mar 1999
Comparative StudyComparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis.
The Alvarado score assigns a numerical value to eight signs and symptoms associated with acute appendicitis. Practically speaking, the Alvarado score is equivalent to one's degree of clinical suspicion. Ultrasound is used in many institutions to aid in the diagnosis of acute appendicitis. The following study compares the accuracy of the two modalities and examines the value of using both modalities together. ⋯ When comparing ultrasound to the Alvarado score for the diagnosis of acute appendicitis, neither one is significantly advantageous. However, the false positive rate is reduced to zero when both studies are positive and ultrasound improved diagnostic accuracy when the Alvarado score was negative or equivocal. There is no advantage of ultrasound over the Alvarado score for the diagnosis of acute appendicitis. Ultrasound is unnecessary when one's degree of clinical suspicion is high. However, the additional information provided by ultrasound does improve diagnostic accuracy in the case of a negative or equivocal Alvarado score. Acute appendicitis is the most common surgical abdominal emergency with a lifetime prevalence of approximately one in seven.
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Subependymomas most commonly appear as a mass in the fourth ventricle of adults; these tumors are rare but must be considered in the differential diagnosis of a lesion arising in this location. We report a case of a fourth ventricule subependymoma.
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Connecticut medicine · Aug 1998
Randomized Controlled Trial Comparative Study Clinical TrialPain control following elective gastrointestinal surgery: is epidural anesthesia warranted?
Fifty-nine patients undergoing elective major gastrointestinal surgery were entered into a prospective, randomized trial between January 1993 and July 1994 comparing the effectiveness, side effects, and hospital costs of postoperative epidural anesthesia (Group 1, n = 29) and intramuscular narcotic injections (Group 2, n = 30). Epidural catheters were inserted by a team that supervised catheter care and infusion rates in the postoperative period. The nonepidural group received intramuscular injections on a regular basis. ⋯ We conclude that epidural anesthesia significantly lessens incisional pain following major elective lower gastrointestinal surgery when compared to analgesic injections alone. However, while not statistically significant, the overall charge was increased by 14% in the epidural group. This finding should be examined in light of the relatively low pain level in patients receiving narcotic injections alone.
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Connecticut medicine · Jun 1998
Teaching senior medical students in an office setting: the apprentice system revisited: a cardiologist's perspective.
The recent changes in medical school curricula, brought about by insurance companies, government agencies, and market forces have shifted the focus of patient care from hospital bedside to office or clinic. Classic approaches to the teaching of medical students in the subspecialties have become confused and inadequate. Students' confidence in their own clinical expertise has been hampered by lack of teaching and guidance, and these functions cannot be filled by higher technology. ⋯ The elective met with enthusiastic support from all students, whose follow-up letters from residencies confirmed the practical value of the course in clinical skills as well as in choice of appropriate higher technology. Although poorly compensated at present, a few plausible suggestions are offered. If structured and coordinated efficiently this practical experience for students can be a real incentive for continued education, inspiration, and pleasure for the faculty monitor, without compromising his or time or income.